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Yyyyyy x. yyyyyy
111 Passaic Ave. #A0000 xxxxxx xxxx , xxxx , xxxxx 00000
xxx-xxx-xxxx
abc@xyz.com
Medicare Hearing Officer & Adjudicator
Compliance Consultant ~ Medical Terminology ~ Insurance Regulations
Results-driven and versatile Medicare Compliance SME seeking a new application of specialized skill set including Operational Support and Development, Training and Assessment Programs as well as comprehensive Data Analysis. Eager to apply these skills to an organization in need of an extremely organized and independent professional astute at streamlining processes and implementing efficiency best practices to increase productivity of operations
CMS / HIPPA Knowledge Quality Assurance Accurate Coding (CPT/HCPCS) |
Medicare Law / Compliance SOP Development Billing Discrepancies |
Program Integrity Fraud & Abuse Investigations Medical Necessity Assessment
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Qualifications Profile
Ø Strong multi-tasking background with the ability to work independently on multiple projects simultaneously, including formulation of policies and procedures, organization development, training and development programs, meeting project deadlines, in-depth problem analysis and solutions, operational process implementation, as well as development and execution of strategies to increase compliance and adherence to Medicare policies.
Ø Extensive knowledge and experience adjudicating medical coding issues, blending well-honed communication skills with CPT/HCPCS/Medical/Pharma expertise.
Ø Thorough knowledge of the proper use and application of medical terminology.
Ø Liaised with myriad professional and medical consultants.
Ø An adept writer and editor, integrating laws, regulations, and corporate policy to produce effective SOPs.
Transferrable Competencies
Ø Effectively strategize with executive management and resolves complex organizational issues related to billing and coding documentation.
Ø Excel in defining and implementing policies, procedures and operational systems that boost productivity, efficiency and quality of operations.
Ø Utilize extensive knowledge of administrative practices and data organization.
Ø Consistently focus on ensuring development of high-standard delivery methodologies.
Ø Proven ability to adapt strong technical skills to diverse organization needs.
Ø Skilled at communicating cross-functionally in order to ensure knowledge sharing is prevalent between departmental lines.
Ø Use knowledge of various administrative functions and company protocols to support and advise executive management.
Ø Embrace corporate culture and actively promotes and leads company initiatives.
Ø Frequently acts as a liaison between customers and various organization departments to ensure smooth communication process.
Ø Technology savvy with knowledge of multiple software applications and platforms.
Select Achievements
Ø Synthesized laws and regulations into readable paragraphs that ensured compliance with Federal/HIPAA mandates and coding guidelines.
Ø Developed parameters and conducted correspondence audits that improved quality and accuracy of the company s responses.
Ø Examined array of issues including proper coding, completing crucial projects within stringent time-frames.
Ø Trained new Hearing Officers regarding complexities and minutiae of Medicare appeals.
Professional Career Track
Medicare Hearing Officer / Adjudicator, Q²Administrators 2006-Present
Medicare Hearing Officer / Adjudicator, Pinnacle Medicare Services 2003-2006
Medicare Hearing Officer / Adjudicator, Group Health Incorporated 1992-2006
Medicare Hearing Officer / Adjudicator, United Health Care 1995-1999
Earlier Experience
- Medicare Hearing Officer / Adjudicator, Adminastar
- Medicare Hearing Officer / Adjudicator, Empire Blue Cross Blue Shield
Academic Training
n M.S. C Physiology/Zoology, Rutgers University
n B.S. C Biology, Fairleigh Dickinson University
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